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Provider Portal User Guide

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1. Hello W CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries sii TAX ID MPI E Facility Name Reports FAQs Contact Us Home MemberInquiry Claim Center Medicaid Info Medical Records Provider News Manual amp User Guide Prior Authorization i Provider Preauthorization Form idit X s fro Form to request preauthorization Provider Manual Provider Authorization Requirements A guide to assist providers and their office staff with providing Care Improvement Plus UM Provider Fact Sheet of Auth Rules services to our members your patients Provider Portal User Guide O a oora Claim amp Payment An instructions to the secure prowider portal Eee eae ee EMR Portal Guide A state based instruction for filing claims with Care Improwement How to Guide for navigation of the NEW Electronic Medical Record Plus for Dual Advantage Plan Members Select a state Submission Portal Provider Direct Remittance DEEE ee Learn how to read a Care Improvement Plus Remittance Search providers within Care Improvement Plus provider network esc Non Contracted Provider Payment Guide A guide from Care Improvement Plus regarding reimbursement for non contracted providers Appeals amp Reconsideration Waiver of Liability Form for Waiver of Liability m M ELEM o This section provides the information about the Audit Concept Recovery Type Claim Type Implementation Date and Description
2. Specialized Care for Medicare Beneficiaries Approved Recovery Category Details Recovery Type Claim Type Date Implemented HE Enter Description Policy Related Links 3 8 Reports Observation Billed in Ispatient Setting Automated Inpatient gt 12 1 2011 Review inpatient claims where observation charges are billed and paid Observation charges should be denied when billed in an inpatient setting as the services are included in the inpatient stay http www cms gov manuals Downloads bp 102 8 pdf ze Benefit Poles Manual Section 20 5 Cutpatient Observation E E This page gives the user the ability to view five medical report types Medical Records Request Audit Findings Reconsiderations and Appeals Activity Payment Summary and the Stargazer report If data is available for these reports it will display in a lookup table once a report button is clicked This page can be accessed from the main menu by clicking the Reports tab or from the Reports dashboard on the home page Provider User Guide Copyright 2015 2015 Page 36 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Bencficiaries W Hello jaimin Log Out v 7 2 b Tutorials CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries v z Home User Name te C TAX ID NPI Facility Name r t FAQs Contact Us Reconsiderations and Appeals Activities Memb
3. d Provider ID Services Date Member NPI D ipti TAX ID AMOUNT Remit P ys l f V r p e After you have made your selection click the Search button A list of Search results should display at the bottom of the screen By clicking on the column headers you may sort the information in ascending or descending order e f you have Claim ID or Optum Payment ID available you may select the appropriate search type enter the Claim ID or Payment ID number and click on Search by ID button to view the claim details for entered information as shown in above figure e he user can hide the Claim Search Criteria or Claim Search Results by clicking on the adjacent E33 icon Provider User Guide Copyright 2015 2015 Page 13 of 53 T CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries e Click the V icon in the View Remit column of the search results to view Remittance EOP in PDF form of the concerned claim if one is available For more information on Remits see section 3 3 1 Claim Details page If the Members Claim does not match to the NPI or Tax ID associated with this User Account and click Search No Records should appear with No Results found message e Under the Claim search results you will see an Export to Excel button This will allow the option to save the Search Results into excel spreadsheet e By clicking on each Claim ID number it will take you to a screen where you can view claim de
4. At least one of the following must be attached Assignment of responsibility AOR Waiver of liability form WOL 1 5 additional documents Pre Service Clicking on Document Upload you will see options for Medical Record Upload and Appeal Reconsideration Request To upload an Appeal and or a Reconsideration documents click on Appeal Reconsideration Request Upload or Click here to upload an Appeal Reconsideration Request link as shown in following figure Provider User Guide Copyright 2015 2015 Page 25 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries W Home Member Inquiry Claim Center Medicaid Info Document Upload Provider News Forms amp Guide Reports FAQs ContactUs Admin Document Upload Medical Record Upload Appeal Reconsideration Request Upload Care Improvement Plus requests medical records according to the Providers may file a formal Appeal following an adverse determination with guidelines set forth by CMS for fee for service Medicare The Plan Care Improvement Plus If a denial was issued due to missing insufficient provides 30 calendar days for providers to fulfill each Bd nd medical records a Reconsideration request may be submitted providers may supply missing medical records or additional documentation for request consideration by the Plan Click here to upload a Medical Record Click here to upload an Appeal Reconsideration Request Clicking on Appeal Reconsideration Requ
5. W CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries Provider Portal User Guide For Eligibility and Provider users Provider User Guide Copyright 2015 2015 Page 1 of 53 PP v8 1 prov Rev 09 21 15 T CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries Table of Contents 1 2 4 5 POr DOSE aoi eie WEISE EINER EU NTEEEES ELE EIER CLE SEERE II SEP TERE NRI EE EEER EVENIRE PEE SOR TENERE SEL EIE DER C EREPEUEES UE EE EUREN DR Ie 3 Aec essine thi Fortal eee R 4 LEOIN e E 4 Ehgibilts User EXDEFICHO osip SANI REN SANSA SI EMI PER RS IVANS ISI TA IS RSN NE EI PUE SM AO RE REPRE 7 Sm Hel UI Mr m 7 SPP sh tois BIA L 9 3 3 CEAN CN EIR C 12 Su MESI DETAIL PACE reion 15 SUM TG Noss e 21 IS DOCUMENT EP ST ee trace U 21 SA ERO VIDE RNE eee A EA E E cess saeiebea aaiaesatadsassataecessass 33 EFOR N S UDE ea E E E 33 PO REPORT eer A E E E E E E 36 A A O e 47 JOC ONTAC TU eE E T N E E T N E T T 48 AKELLA IANS A E I A A E OEN IR A A OA E E 50 MIS CLANINIOR uer a E E E E EE
6. e Provider Communication PATH Medicare Advantage HEDIS Improvement Program MA HIP FAQ s e Provider Communication PATH Medicare Advantage HEDIS Improvement Program MA HIP 2014 Terms and Conditions e Provider Communication Wellness and Physical Examination Codes e Provider Communicaton Gold Card e Provider Communication ICD 10 Transitions Basics and FAQs Contact Us Provide Health Plan contact information for available e mail fax and phone numbers Allow the user to send feedback on feature and functionality This report allows providers to review claims payments and or recoveries Copyright 2015 2015 Page 37 of 53 T CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries e To access either the Medical Requests or Audit Findings Reports simply hover over the Post Payment Audit sub menu field as shown in the picture in previous page You will then arrive on the Reports search page with criteria in which to search for reports A provider user must select one of the Tax ID or NPI numbers they are as signed to in the application first Payment Summary Reports Date Range Search Tax ID v Patient Acct Check Ref Id Date of Service Range O Paid Date Range From 1 1 2013 v To 6 1 2013 hd Payment Summary Export To Excel Current Gross Net Current Current Current Current Check Provider Patient Acct Check Check Rec overed Check Chec k Current Membe
7. 53 Provider User Guide Copyright 2015 2015 Page 2 of 53 ir CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries 1 Purpose This User Guide is for Eligibility and Provider users of the Provider Portal web application a secure web based application to access information provided by Care Improvement Plus This guide provides a detailed overview of the application s functionality based on a menu driven sequence as displayed in the Home Page as well as an intuitive dashboard interface for all sections on the landing page for a more visual experience It also provides a step by step process on how to use the application and all of its features effectively Provider User Guide Copyright 2015 2015 Page 3 of 53 br CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries 2 Accessing the Portal 2 1 Login 1 To access the Provider Portal click on the link below https providerportal careimprovementplus com This log in box will appear W CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries Login Information Please enter your username and password Welcome to the Care Improvement Plus Provider Portal Username Whether you are a Participating or Non Participating Enter username here Provider you can access the Provider Portal Password If you want to register as a new user please click Enter password here View Self Registration tutorial Key in your Use
8. CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries CARE IMPROVEMENT PLUS Specialized Care for Medicare Bencficiaries As a Provider user the user will have access to more features in addition to the features Eligibility users are able to access Claim Center Document Upload Reports Home Member Inquiry Claim Center Provider Alert Please review report for 462 patient s Medicaid Info Document Upload Provider News Member Inquiry The section offers several options to retrieve member information as well as verify the member eligibility and eligibility history Claim Center To view detailed information on payment status and amount claim amount and charge code detail See the copy of the remittance related to the specific claims Review reports for Medical Records Requests Audit Findings and Reconsideration amp Appeals Activity related to the specific claims Request Remittance Details e Send a Claim dispute Forms and Guides Provide all forms and guides related to Prior Authorization Claim amp Payment Member amp Benefit Information Part D Claim Part D Coverage Determination and Redetermination Part D Mail Order Form Video Tutorials e Featured Video Tutorial ify member eligibilit Um m en o_o CAMS MPERA NT PNS Fm osos Mete oe mmu hreim ar ren rant aee ZEW ee Provider User Guide Upload up to five docu
9. Copyright 2015 2015 Page 42 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries members eligible for the screening as well as current and prior reporting peri od compliance is shown with the number of members required to reach HEDIS and SUPERIOR adherence rates included Quality Outcomes and Clinical Performance represent performance based on HEDIS and or STAR specifications o MAHHIP Summary Report Total Physicians M Total Patients 1 Total Open Care Opportunities MD The following data shows metrics for HEDIS measures that indicate a potential care opportunity Metrics include Medicare members specific to MA HIP Program Total Patients C C01 Colorectal Cancer d C10 Care for Older Adults Medication Review m 182 EE 46 Zm 3 2 3f B r EENCENN NC M 0 NN pe Pos 11 84 a 97 83 C12 Care for Older Adults Pain Assessment 166 C14 Diabetes Care Bt Exam 155 C16 Diabetes Care Blood E E 218 D09 High Risk Medication 12 3s D11 Medication Adhara for Diabetes um f ra D13 Medication Adherence for Cholesterol 63 Statins This report displays the following key fields Physicians Displays the total number of physicians within the provider group assigned or attributed as the PCP for a member Total Patients Displays the total number of members with an assigned PCP that is part of the provide
10. Coverage Determination and Redetermination Part D Mail Order Form Video Tutorials e Featured Video Tutorial ify member eligibili mm cuu IDE DS Ans CME MIFIT PIN A ities Cam de Unde lera dame E ve suum LE sed i emt t te me can Provider User Guide Upload up to five documents in electronic Medical Records eMR Upload e View Provider Alert in Home menu based on Patient Care Opportunity Report PCOR measures Providers may now upload the Authorization of Representative AOR e For formal appeals providers may now upload the Waiver of Liability WOL Medicaid Info Provide Filing Claim information for State base Dual Advantage Plan Member Document Upload 1 Medical Records Submit Medical Records electronically for Post Payment Audit Reviews 2 Appeal Reconsideration Upload Submit missing medical records or additional documentation electronically for Appeal or Reconsideration request Reports 1 Post Payment Audit Medical Records Request Provide status report of submitted medical records and or additional documentation Audit Findings Provide status of a claim audit 2 Reconsiderations and Appeals Activities Provide status of a Reconsideration and or appeal 3 Payment Summary Release Note V7 2 d EMR Portal Guide Sequestation Implementation Provider Portal User Guide Featured Training How to verify member eligibili Provider News
11. Door Iu poo ee De drm doque cg TIR camere m 30 98 d ob ne boss eee No eom Le elo m a AD nD Atra d t ovarunhs wt Ld oatben Anas hee eet ELIT AIME M denm mom un ramo sena memet How to veri ost payment audit CB VER RT IUS tet ord ir b non dr Dp eic ae le Tus OO UMS RK ROO Y mor aw p e a a p 9 m o Aes o eee woe versas Tome is ama com imn rum exin 9m im Ld me nmm m omma Ded She on mm m Anh ndm LMEI1l ER DNUS oreo moo e y Dainai og tee LL AE DL tT a os ico cal Amd ani ara ab ansam cae meno amt teen Z me asn lt r ee taai cn a s am finga tan id asma 2 Tem oun tw P m d Dom U eon n Mamm n Appeal and Reconsideration Upload W VEE WIE MEN 8 UIS Mrs Ton jn m rmm r Do we emma e a e m f tulit ent Moo e Cua om sire den died emm om ume FNAC se mm amem md irm omm ova tese naa mmt natnm n meal vica de swe cated oco em A naci Lac ecco now vem re Fdo Sern thee lada nnl m A une men lo Re i pma uomen A na natn arae ara asa mem Provider User Guide Copyright 2015 2015 Page 52 of 53 W CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries Disclaimer e Care Improvement Plus has made every effort to ensure that this User s Manual is accurate and up to date Care Improvement Plus disclaims liability for any inaccuracies or omissions that may have occurred and makes no commitment to keep the information up
12. ID please click Help Document ID lookup If you did not receive a letter please click I don t Have Document ID Decision Type Document ID o Help Document ID lookup I don t have a document ID Submit Documents User can browse select the Appeal Reconsideration letter and other supporting documents and submit them by clicking on Confirm and Submit button Provider User Guide Copyright 2015 2015 Page 27 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries Appeal Reconsideration Request Facility Provider Appeal Reconsideration History You may provide a different email address for receiving the confirmation email Click the Appeal Reconsideration History Provider Facility Name button to see detailed Upload History 3 Appeals Reconsiderations were Provider Name EN uploaded Most recent completed upload Document Provider Tax ID Provider Email Provider Fax Confirmation Email Address Decision Type Please type the Document ID that you have received and then click the Submit button If you received a letter but don t know the Document ID please click Hel Document ID lookup If you did not receive a letter please click I don t Have Document ID Document ID Help Document ID lookup I dont have a document ID J Appeal and Reconsideration Upload This i an Appeal and Reconsideration Upload Please attach the letter of appeal waiver of liability form or any ad
13. are able to effectively conduct health care transactions on or afier October 1 2074 using the ICD 10 diagnosis and procedure codes IGCD 9 diagnosis and procedure codes can no longer be used for health care senaces provided on or after the compliance date of October 1 2014 Last Updated On 10 9 2013 Why is this transition to ICD 10 happening 3 10 Contact Us This page provides Health Plan contact information related to claims submission Appeals Inpa tient Hospital Admission Authorization Eligibility Inquiry and Web Portal Support such as e mail fax TTY and phone numbers Provider User Guide Copyright 2015 2015 Page 48 of 53 W CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries Provider User Guide Copyright 2015 2015 Page 49 of 53 W CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries 4 Tutorials This section provides the tutorial videos about the different functions of the portal and helps user to understand how to navigate the system and use its specific features The tutorials section can be access through the Tutorials tab on upper right corner of the portal Mi 3 00 Pid 7 rEN 1 200 711 1558 phar 1 X0 24L 10607 Providers 1 B55 575 3115 Hallo Leg Out Pant Vi amp 2 Tutorials W CARE IMPROVEMENT PLUS a Usar hama A 5 lived C Medicare BReneficiar TAX ID NPI peciadin are for Medicare Bene firiavies Facility Mamet d ID I Home Mambaeri nquiry Claim Ca
14. of the Audit By using this link the user can look back over 4 years of review data from the current date o The user can also sort the list alphabetically by clicking on a specific column title to change the default order of items listed by Audit Concept and the mplementation date column can be sorted chronologically To jump to another page please click on the pagination on bottom of the table Please refer to the following image Provider User Guide Copyright 2015 2015 Page 34 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries Audit Concept Recovery Type Claim Type Implemented On ome man Automated Age Inappropriate Services Annual Wellness Visit LAWN Overpayments Back Braces with Inappropriate Modifiers Claims Billed on HCFA 1500 and Ug usa CPAP Withaut Sleep Apnea Test ar Dx Diabetic Shoes DME unlisted Procedure ome 2032 12 1 2011 Professional 12 1 2011 E amp M Upcoding E amp M Same Day as Debridement La a ul o Click on any of the Audit Concept list links and a new window will open up with the details of the recovery category along with Policy Related Links if any exist To re turn back to the Approved Recovery Categories list view page simply click on the close button or the X icon located on the top right corner of the box Provider User Guide Copyright 2015 2015 Page 35 of 53 ir CARE IMPROVEMENT PLUS
15. team A message will appear stating that your request was sent successfully and a response will be sent to you within 1 3 business days Your notification to Care Improvement Plus is ready to be sent Please add any additional comments you feel would be pertinent When finished click Send Notification or press Cancel to return to Claim Summary screen Email Address Required Requesting EOP document for member for Claim send Notification Click the Dispute Request button on the Claim Detail page to request an explanation about the claim A dispute window will prompt the user to answer OK or Cancel Claim Summary Remittance Information Claim ID Provider Name Member ID Covered Under Care Improvement Plus Silver Plan 100 Subsidy Patient Acct Dates of Service 05 10 2011 to 06 01 2011 Servicing Provider Address NPI Paid on this Claim Received 06 07 2011 Payment Information Status PROCESSED ek sheik Primary Diagnosis Code 27803 DRG Code 208 Payment Ref ID Place of Service Payment Date Note Check Amount Combined Check Check Status All Post Payment Audit Reports Dispute Request Reason Provider User Guide Copyright 2015 2015 Page 18 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries W Message from webpage X G By providing you with access to the CIP Provider Portal the o information contained within the portal is provided for your use
16. to another page by clicking on the page number located below the table Another feature under the Stargazer Summary is Export to Excel This button allows you to save and print an excel spreadsheet of members you received in your Search Results Provider User Guide Copyright 2015 2015 Page 39 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries Export To Excel Not Adherent 59 26 Lisinopril Tab 20 MG na na 100 00 qna J na EE NNNM NNNM ONES CNN Adherent 98 36 Losartan Potassium amp Hydrochlorothiazide Tab 50 12 5 MGna 9 84 Adherent na 333696 fgg o Not Adherent65 69 Lisinopril amp Hydrochlorothiazide Tab 20 25 MG Not Adherent76 64 _ Adherent Adherent na rt 880 Patient Care Opportunity Report PCOR Patient Care Opportunity Report for CIP members provides information regarding members where screenings or tests are recommended User can access different types of reports under PCOR 1 Group Level Summary Report MA HIP Summary Report Not available for year 2014 Physician Level Summary Report Member Adherence Report Pharmacy Detail Report p Wr s S Ie MA PCPi Level Summary Report Not available for year 2014 Note Images in this section are showing data for year 2015 PCOR report for year 2014 may have slightly different data Provider User Guide Copyright 2015 2015 Page 40 of 53 Home Member Inquiry Claim Center Medicaid Info Documen
17. 00 690 1916 e f the user has a Provider role that links to a specific Providers Tax ID or NPI listed in their View Recent Claims User Account the user will see the f icon By clicking on this icon the user will be able to view the most recent claims submitted by that member Claims A View Recent Claims e The user may view the summary of a member s healthcare benefits plan by clicking the coverage plan information link found in the Member Eligibility History section Provider User Guide Copyright 2015 2015 Page 11 of 53 ir CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries Member Eligibility History Eligibility Medical Product As of 11 8 2013 is Eligible for coverage under Arkansas Gold Rx Regional PPO Plan plan for the period of 01 01 2009 to Present 3 3 Claims Center This page is accessible by any user that has provider role access to the application Eligibility users will not be able to have the option The Claim Center page is useful To view detailed information on payment status and amount claim amount and charge code detail To see the copy of the Remit related to the specific claims To review reports for Post Payment Audit Report such as Reconsideration amp Appeals Activity Medical Records Requests and Audit Findings related to the specific claims To request Remittance Details To send a Claim dispute There are two ways to reach to the Claim Center page
18. Copyright 2006 2015 Care Improvement Plus b To view Claim Information Provider user e Select radio button I agree to use the Provider Portal to view Ulaim intor mation gt Click Agree e You will need to call Provider Portal Support 1 800 690 1916 to set up the account e You will also be able to view the Eligibility Information 6 Once you are able to logon the user will arrive on the Home Page Tutorial Videos The user can also access the Self Registration Tutorials through the Log In page Provider User Guide Copyright 2015 2015 Page 5 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries VV W CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries Login Information Please enter your username and password Welcome to the Care Improvement Plus Provider Portal Username Whether you are a Participating or Non Participating Enter username here Provider you can access the Provider Portal Password If you want to register as a new user please click Self Register Enter password here Jas Visas View Self Registration tutorial Provider User Guide Copyright 2015 2015 Page 6 of 53 3 3 1 Home available to the user Home Member Inquiry Medicaid Info Provider News Forms and Guides FAQ s Contact Us Home Member Inquiry Medicaid Info Provider News Forms amp Guide FAQs Contact Us W Eligibility User Experience As a
19. How to self register W LARE WUPROUE ENT PUIS mov oe inn re semis roo mor ms os m e hm iays lcs 1 e How to veri Y CARL ROVE Hus ret ad amp Moo toph deum Bele bee vs o Ms Pw Pte cele serried te mm ete enam m rtm 5 I member eligibili eo C wo howe ruote LEM ol uid u ir t M m Me e mes De mmie y rnm tnm w ere ert ee re nn Domno ed tma m eme Wes c wet CAM MIPRIETUP SR ST FS beein Cam dme a nt M mee dno reer Pama eer uro ote te re mames am s m mom L fmemvwaiv s e Rate I d 7 o Bie am n fmm deme wA eet wees e te TENTE Mom mh ck d de cos Mele Reo Pam me s LLL LL err Ls c bM sum iP hom emma oc Rm or oe mm Mee m amm Tm bend em Se M Pl wawd S4 ee ram eee nA norm mmm orm few ste Pat We cwm anm nma hoy emeret rennet n s X LM UUPRMTWN HUS Daka feeds Anew deanery Rie woollen ty eme ee aln e m an Yap EE umo deem oam Cte Ped KI Ber Bere oue arbo MUR TROP A zmo ees dnas Wi a 8 Pes as thaat a mm ee a aal C vea Dv ated mm env ow Mn MM i Pal ovwed ad acm Sia ai Do d Peon ma s 9 d namo Eugen 128 4 4 A De Tota Penes 2 ien Partis bates tere Ls cen od L mdran ma aiias ber ome Y CME MAPOVANIE LIS ipri Cer fe i at arry Aveia ll om Das nma vem Mo ai omm e P EC AEU LAT
20. ID Member Name Member Date of Birth Date of Service From date Date of Service Thru date Medical Record File Please choose the Medical Record File by clicking on 3rowss button Then Cick Submit button Note If a password restriction has been placed on the document please remove ihe restriction prior to upload Choose Medical Record File Browse Add Another File Submit If you do not have the Document ID you can click on I don t have Document ID and you will allow to enter a claim ID number After entering the Claim ID all associated document IDs will show up User can select the appropriate document ID or choose don t know document ID in case does not know the associated document ID number These steps will auto populate the Member information and allow user to submit Medical Records via Medical Record File section User can click to Add Another File button to upload additional button Users are allowed to submit up to five documents via clicking on Submit button Note User may upload PDF JPEG TIFF or XML type of file format and maximum size of the file should not exceed more than 60MB Provider User Guide Copyright 2015 2015 Page 23 of 53 W CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries User can view all the total numbers of Medical Records Upload and Most recent upload details via Medical Record Upload history Clicking on Expand Upload History will show all pre
21. NEL dme bati himan om syne SSR Neto mete rea t rm mem men aa tat narani sanae gm onm nont Fumo LE met A nam ni trm ir samy ot monde ls tdi tica raim oar d i v qori ran Maki LAL La e Od 021 M UMSO peo iva lem lena Dew o ow tapara Saki Pru i amd m eA er inm gt tAr Dwnn XX Med AM Ha nante cma PET a How to request a remit if one is not immediately available ee te M a CARD OPED DENT A Atem s m uuu Mess eR Pa ww catum nh rra a t c Q Mei m ocho do cm he tet coma dade m v rn Penra scu mbar w ccm ots amd ames odo wh dear te oom hat de E uror ee om Sev d aum a Saaw ciet How to view forms and quides e mem juau Wet Eg roa caus CARE MIFRERSENT PS aay a gt Seba mies DII mM er ev deben con iere deum eem ms om ar re bap os area Tr Is Sees oov Vm d and ee orm ame el odorum pen t snnt mor ce eot hom om vna Com Leg ee o E nie 0 uou 5209 geo qat uet a m he How to view provider news cwm ov tnde wc uoo PN ao se vy CARE VERE MENT FILS riche IANG DARAN oe IDE w c m eR eod Rey Pa eni h t age me ta hat 7 arene Seer coim mmi cum rome qno Rm o ra jo mam Oct wx f Lm s MIDI FED NOR MEE Ron e a Rn sous Pauli e calm Pu LP CC 090 NL On Westm dtm UM Feo FD Meet et we dw mm orm m ma aa tme hv iy Em ndi sd C d spam s m MES Fasc ama nes d A s mal mirate Candles a tts Bombe rac e J ee i Cai
22. On the Member Detail Page click on the View Recent Claims icon or from the main menu by clicking the Claim Center tab On this page You will see a Search Criteria Box You will have the option to search by claim type Facility or Medical You may enter in dates of service date range this defaults back to a 6 month span or use the calendar to pick dates By clicking on the drop down box next to the Status field you can choose from a list of options Processing Processed and Adjusted Claims The Members First and Last Name will be carried over from the Member Details screen if you access this page from the Member Details page Otherwise you can click the search icon q to find the member first Provider User Guide Copyright 2015 2015 Page 12 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries e Home Member Inquiry Claim Center Medicaid Info Document Upload Provider News Forms amp Guide Reports FAQs Contact Us Claim Search Criteria Advanced Search 9 Tax ID Claim Type Facility 3 Date of Service From 12 22 2014 mm dd yyyy Date of Service To 6 22 2015 mm dd yyyy Claim Status Any Status x N Member Q Provider NPI Payment Ref ID Member First Name Member Last Name Member Date of Birth mm dd yyyy Claim Search Claim ID j Search by ID Optum Payment ID Claim Search Results Exportto Excel Claim ID Service Provider Claim CHECK View
23. Program Latest Date Forms Forms Interim Patient Status Exceptions Generated Generated Returned elected Processing Status PSE CNA m EE TOTAL PATIENT DIABETIC PATIENT 4 n p Incomplete Forms Relevant Open Care 9 o Relevant Open Care E Patients metier pans Adherent Patients Mn f C01 Colorectal Cancer Screening CO08 Adult BMI Assessment C10 Care for Older Adults Medication O Review Jo 3 9 FAQs This section provides information pertaining to any questions the user may have This is a key word driven search engine Provider User Guide Copyright 2015 2015 Page 47 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries W Type the question or keyword Minimum 3 characters in the search text box field and all the information related to search field will be shown under the search option The question can be expanded by clicking on icon to find the related answer It also contains related links such as Provider Communication and CMS Resource Related information can be found by clicking on any of this links The user can also find the last updated information on bottom right corner of the answer d Seah What is the ICD 10 compliance date and is there a chance this can be postponed What does ICD 10 compliance mean IGD 10 compliance means that al Health Insurance Poriability and Accountability Act HIPPA covered entities
24. Remittance Advice Servicing Provider Name Servicing Provider NPI Subscriber Claim ID 5 mws 73 tae erdt Keep in mind that the processing for this claim may still be taking place and that it might take longer for this to be completed due to the timing of the submission i e prior to a holiday week end etc Usually a good rule of thumb is to wait around 6 7 days after the claim was first submitted to ensure its availability If the claim payment is processed prior to July 1 2009 the user will automatically be directed to the Request Remittance Window as shown below where the user can enter a valid email address and or fax number to have the Remit image is sent The Remittance Information for this payment is not available via this website Please click Request Image button to request image or press Cancel to return to Claim Summary screen If you prefer to receive image via fax please provide an email address and a fax number Email Address Required Fax Optional 24 Request Image Provider User Guide Copyright 2015 2015 Page 17 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Bencficiaries W Clicking the Request Image button will then open the notification window where the user may add any comments or notes regarding this claim request Fill in all necessary information and then click the Send Notification button to send the request to Provider Portal support
25. ails Displays basic Member Information such as member name subscriber ID Date of Birth and Gender Member s PCP as per Health Plan records Eligibility History and Member Plan details Provider User Guide Copyright 2015 2015 Page 10 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries VV Member Information Name Subscriber ID DOB Gender Male Primary Care Provider PCPs Member does not have a Primary Care Physician Claims 4 View Recent Claims Member Eligibility History Eligibility Medical Product As of 11 8 2013 is Eligible for coverage under Arkansas Gold Rx Regional PPO Plan plan for the period of 01 01 2009 to Present Eligibility Report Product Name Arkansas Gold Rx Regional PPO Plan Eligible Eligible Effective From 01 01 2009 Effective To Present Product Name Arkansas Gold Rx Regional PPO Plan Eligible Eligible Effective From 06 01 2007 Effective To 12 31 2008 To receive benefit information for any products other than available above please contact Provider Services at 1 866 679 3119 Primary Care Provider PCPs Displays the member s Primary Care Physician as per Care Improvement Records e Claims displays a link to the Claim Center search page If the user is an Eligibility user the user will see a message Currently your User account is for viewing Eligibility If you would like to add Claims permission please call Web Portal Support 1 8
26. ation Update 14109 RECONSIDERATION mpm m Update QT noen emm 01 08 2014 Appear Chaim Files have been inso gt APPEAL m m m Update 01 08 2014 Appear Claim Files have been Provider User Guide Copyright 2015 2015 Page 32 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Bencficiaries W 3 6 Provider News The most recent updates news items will display in this section The Top 5 most recent news items will display in this panel and clicking any of these will open the news detail as a PDF document Clicking the header of the Provider News panel or the Provider News main menu tab will open the public Provider Portal News section in a new browser window and display all news items 3 7 Forms amp Guides Provides all forms and guides related to Manual amp User Guide Appeals amp Reconsideration Prior Authorization Claims amp Payments Medical Record Reimbursement Member amp Benefit Information Part D Claim Part D Coverage Determination and Redetermination and Part D Mail Order Form Manual amp User Guide Approved Recovery Category Audits can occur 4 years fram the initial determination date Provider Manual A guide to assist providers and their office staff with providing services to our members yaur patients Provider Portal User Guide An instructions to the secure provider portal EMR Portal Guide How to Guide far navigation af the MEW Electronic Medical Record Submi
27. ce Details Payment Information 06 07 2011 PROCESSED Check Numbers 27803 Payment Ref ID Payment Date Check Amount Combined Check Check Status All Post Payment Audit Reports Dispute Request Copyright 2015 2015 Page 20 of 53 T CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries 3 4 Medicaid Info This page provides claims filing information for Care Improvement Dual Advantage Plan Members in the following eligible states Arkansas Georgia Missouri South Carolina Texas and Wisconsin 3 5 Document Upload This section allows the provider users to submit upload the medical records Appeal Redetermination Reconsideration Technical Denial upload Click on the Document Upload menu and go to the appropriate module to upload the intended documents Home Member Inquiry Claim Center Medicaid Info Provider News Forms amp Guide Reports FAQs ContactUs Admin Document Upload zm l Medical Record Upload The Medical Records upload module allows the user to submit upload electronic health records requested by Care Improvement Plus It also allows the user to find the Medical Record Upload History by clicking on the Expanded Upload History button on the top right corner of the page To upload the Medical Record documents click on Medical Record Upload or Click here to upload a Medical Record by using Document ID link if you have document ID you may find this in Medical Record Request lette
28. date or current e Information in this manual is subject to change without any prior notice No part of this manual shall be assumes any liability to the users e All rights are reserved to Care Improvement Plus Provider User Guide Copyright 2015 2015 Page 53 of 53 PP v8 0 prov Rev 09 21 15
29. ditional decumaenta ton nacess ary for your appeal and reconsideration upload Upload Supporting Documenta tion LCOPDWOA Add Anoth er File appeal If you have already uploaded an AOR or a WOL form or you are not required to submit either of those forms you do nok have to separately upload them below Upload an ADR Browse i an ra Download AOR Form Upload a WOL Browse t t E NOI Download WOR Form Corim and Subrat If you do not have the Document ID or the decision letter you can click on I don t have Document ID and you will allow to enter a claim ID number You can look up the document ID with the date of service plus one of the following 1 HICN 2 Member Name and Date of Birth Provider User Guide Copyright 2015 2015 Page 28 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Bencficiaries W 3 Subscriber ID Please enter the information below in support of your request Please enter the following information Date of Service From MMDD YYY Date of Service Thru MM DDJ YYY Y AND Please enter the field s in one of the following sections HICN Beneficiary Medicare Number Member First Mame Member Last Name Member Date of Birth MM DD YYYY OR Subscriber ID Proceed to upload documentation Note If you are unable to locate or look up the document ID number using other information you can submit a manual routing request For mor
30. e claim payment is after July 1 2009 Prior to showing the available Remit file a confidentiality disclaimer message will be displayed see below Message from webpage i x Ah By providing you with access to the CIP Provider Portal the o information contained within the portal is provided for your use to identify CIP member daims benefits and eligibility The materials and information on the portal are private and may contain confidential protected health information PHI that is legally privileged This information is intended only for the use of the individual or entity being provided with access to the CIP Provider Portal The authorized recipient of this information is prohibited from disclosing this information to any other party unless required to do so by law or regulation and is required to destroy the information after its stated need has been fulfilled If you are not the intended recipient you are hereby notified that any disclosure copying distribution or action taken in reliance on the contents of the information on the Provider Portal is strictly prohibited Clicking OK will then display the PDF as shown below Provider User Guide Copyright 2015 2015 Page 16 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Bencficiaries W CARE IMPROVEMENT PLUS PAYMENT SUMMARY Specantied wre Jer Mevroare enedioanes Questions or Concerns Contact Provider Services at 1 866 679 3113 TTY 711 Provider
31. e information see the Submit a Manual Routing Request procedure at end of this section After entering the document ID or proceeding through I don t have document ID you can proceed to document upload and browse for the document select the Appeal Reconsideration letter and other supporting documents and submit them by clicking on Confirm and Submit button Provider User Guide Copyright 2015 2015 Page 29 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Bencficiaries W Note User may upload PDF JPEG TIFF or XML type of file format and maximum size of the file should not exceed more than 60MB Submit a Manual Routing request If your request was not found when you search for the document ID via don t have document ID within two attempts an option to submit a manual routing request will appear at the bottom of the page Click on Submit Manual Routing Request to begin Appeal Reconsideration Request Enter HICN and date of service member info and date of service information or subscriber ID and date of service information Please enter the information below in support of your request Please enter the following information Date of Service From 01 01 2001 Date of Service Thru 01 01 2001 AND Please enter the field s in one of the following sections HICN Beneficiary Medicare Number Member First Name If your request was not found uoadbor Lat Mei ou may enter it manually by c
32. e sent Please add any additional comments you feel would be pertinent All attached files must be in Microsoft Excel format When finished click Send Notification or press Cancel to return to Claim Summary screen Email Address Required Browse Upload Excel only Maximum Files to Upload 3 Atach Files f gend Notification Cancel When attaching file s click the Browse button to search for a local Excel file to up load then once selected click Open in the file selection window The path to that file should now be listed in the field next to Browse Click Add to add it to the queue of Excel documents to be uploaded Once you ve selected up to three documents that you wish to include click Upload to send them to the database Once the Send No tification button is clicked the IT staff and vendor will receive an email with this in formation including links to all the Excel documents that were attached You will be redirected to Post Payment Audit Reports by clicking the All Post Payment Audit Reports button Claim Summary Claim ID Member ID Covered Under Patient Acct Dates of Service Servicing Provider Received Status Primary Diagnosis Code DRG Code Place of Service Note Reason Provider User Guide Remittance Information Provider Name Care Improvement Plus Silver Plan 100 Address Subsidy NPI 05 10 2011 to 06 01 2011 sd cu didt Request Remittan
33. edicare Beneficiaries HRM Rx Alternatives Glossary ortto Excel g Group Level Summary Report Total Physicians 175 Total Patients 789 Total Open Care Opportunities gt indicate a s care opportunity The following data shows metrics for HEDIS measures that Metrics include Medicare members specific to Total Patients C01 Colorectal Cancer Screening C10 Care for Older Adults Medication Review C12 Care for Older Adults Pain Assessment C14 Diabetes Care Eye Exam C16 Diabetes Care Blood Sugar Controlled D09 High Risk Medication D11 Medication Adherence for Diabetes Medications D13 Medication Adherence for Cholesterol Statins This report displays important information about total number of physicians within the provider group assigned or attributed as the PCP for a member and total number of members with an assigned PCP that is part of the provider group Total Patients This report also gives detail summary of number of Patients for relevant Quality Measures open care opportunities Non Adherent and Adherent percentage Prior Adherent Reporting Period percentage Adherent Trend Quality Rating and Adherence Target percentage MA HIP Summary Report summarizes the MA HIP membership for each recommended HEDIS and Part D measure as well as whether the quality targets have been met and a summary view of Annual Care Visit performance Additionally the number of Provider User Guide
34. equire more than one visit to meet the required preventive care We hope you find this information useful and appreciate the care you provide to your patients who are Care Improvement Plus members This report includes patient care opportunities for Care Improvement Plus members who meet criteria for healthcare services specific to evidence based quality indicators and include patients who may be soon due or overdue for care Not eligible for the measure On track for adherence Adherent forthe measure At risk fr being nonadherent Not adherent fr the measure Not adherent Part D measures only Medication adherence measures only PDC value is displayed for prior year adherence red bnt indicates non adherence Annual New Member Member ae va Member Member Member Care Care z HQPAF HQPAF HQPAF Physician pem First E ID DOB Phone Score Visit Diabetic Generated Received Status atient Name Name as F mmummzmuumn hoho ff re This report has following key fields Member ID The number found on the member s identification card For some dual eligible members the field may be blank Care Score is a Care Improvement Plus calculation which uses a combination of a measure s adherence status and the weight of the HEDIS and or pharmacy measure for each relevant member Its purpose is to quantify the care needed for each member based on CMS guidelines Provider User Guide Copyright 2015 2015 Page 45 of 53 CARE IMPROVEMENT PLUS S
35. er Inquiry Claim Center Medicaid Info Document Upload Provi Medical Records Request Audit Findings Medical Records Request Reports Date Range Search Payment Summary Tax ID Stargazer PCOR CIP 2014 PCOR CIP 2015 Selecta TAX ID z Date of Service From Null v Null v Date of Service To Providers can also access the 2015 PCOR report from the main menu by clicking on the patient numbers under the Provider Alert section on the home page Please review the Patient Care Op portunity Report PCOR section for more details Home Member Inquiry Claim Center Medicaid Info Document Upload Provider News Forms amp Guide Reports Contact Us FAQs Provider Alert Please review report for 462 patient s Member Inquiry The section offers several options to retrieve member information as well as verify the member eligibility and eligibility history Claim Center To view detailed information on payment status and amount claim amount and charge code detail See the copy of the remittance related to the specific claims Review reports for Medical Records Requests Audit Findings and Reconsideration amp Appeals Activity related to the specific claims Request Remittance Details Send a Claim dispute Forms and Guides Provide all forms and guides related to Prior Authorization Claim amp Payment Member amp Benefit Information Part D Claim Part D
36. es TAX ID NPI Facility Name Home Member Inquiry Claim Center Medicaid Info Medical Records Provider News Forms amp Guide Reports FAQs Contact Us Stargazer Reports Member Stars Detail Search Tax ID Selecta TAXID v Glossary Date Range End The claims through date the date range is based on a rolling 12 months Date Range Start The date of the first prescription fill within 12 months of the end date Proportion of The total days covered by prescription fills divided by the number of says in the date range after adjusting for overlaps and acute Days hospitalizations Recent Drug dein Displays the drug name of the last Hypertension Oral Hypoglycemic or Statin drug filled Compliant Proportion of days covered gt 80 Not Adherent Proportion of days covered lt 80 na Member did not meet the eligibility criteria of 2 fills within the past year If a member is Non Compliant that indicates the member has not received the required screening or test for that required measure If a member is listed as Compliant the member has met all requirements and requires no action If a or na is listed the member does not qualify for that measure and does not require and action User can find the Glossary on bottom of the table for detailed explanation about the terms e User can scroll the report horizontally through the scrollbar and also jump
37. est will open up appeal reconsideration document upload module with pre populated information such as provider facility name provider name and provider email address associated with the account If user s account is associated with multiple Tax ID NPIs then user should select the one from the Provider Tax ID NPI drop downs menu After selecting the Tax ID or NPI from the drop down menu Provider Facility details and Appeal Reconsideration History will show up User can type in confirmation email address if wants to receive confirmation email on other than displayed email address Facility Provider To upload a Medical Record please choose the Provider NPI from the menu You may provide a different email address for receiving the confirmation Provider Facility Name E H EM Provider Name s mcum s E Provider NPI Provider Email Confirmation Email Address Type in the document ID number in the Document ID field and the member information will be populated User can submit the related documents such as letter of appeal reconsideration waiver of liability For non par provider only and additional documents through the Appeal Reconsideration Documents Field Provider User Guide Copyright 2015 2015 Page 26 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Bencficiaries W Please type the Document ID that you have received and then click the Submit button If you received a letter but don t know the Document
38. estation Implementation Provider Portal User Guide FAQs Featured Training How to verify member eligibili Provider News e Provider Communication PATH Medicare Advantage HEDIS Improvement Program MA HIP FAQ s e Provider Communication PATH Medicare Advantage HEDIS Improvement Program MA HIP 2014 Terms and Conditions e Provider Communication Wellness and Physical Examination Codes e Provider Communicaton Gold Card e Provider Communication ICD 10 Transitions Basics and FAQs Contact Us Provide Health Plan contact information for available e mail fax and phone numbers Allow the user to send feedback on feature and functionality Page 8 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries W 3 2 Member Inquiry This section offers several options to retrieve member information as well as verify the member eligibility and eligibility history When you click the Member Inquiry menu you will get the following search screen Search Criteria Provide one of the following minimum 2 letters First Name Last Name AND One of the identity field s Subscriber ID Medicare ID Date of Birth mMmm 0D YYYY Medicaid ID Additional Search Criteria ZIP City State ALL Y indicates mandatory entry Add to Mass Search List Search Result Export to Excel e Under Search Parameters you can enter any combination of the f
39. fied on the Member Compliance Report Quality Rating A calculated field showing current adherence for that metric for that group based on th e 2012 CMS STAR Rating thresholds Open Care Opportunities Displays the total of gaps in care for the HEDIS measures and Pharmacy current year gaps as defined by the alert levels on the Member Adherence Report where R Gap Y2Gap and G No Gap Physician Level Summary Report also displays the detailed information for Physician Name Quality Measures Relevant Patients Open Care Opportunities Non Adherent Provider User Guide Copyright 2015 2015 Page 44 of 53 W CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries and Adherent percentage Prior Adherent Reporting Period percentage Adherent Trend Quality Rating and Adherence Target percentage Member Adherence Report Summarizes care opportunity data by physician MPIN each HEDIS and Part D measure Member Adherence HRM Rx Alternatives Glossary Exportto Excel Member Adherence Report According to our records the following patients have been identified as having care opportunities for preventive services for selected quality indicators based on the nationally recognized HEDIS performance measurement set Please check your records to validate the information and if the patient needs these or other services we would appreciate you performing those services We understand that some of the patients may r
40. licking Submit Manual Routing Request Member Date of Birth 01 01 1921 OR ID Request was not Found Proceed to upload documentation Cancel Provider User Guide Copyright 2015 2015 Page 30 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries W Click the Submit Manual Routing Request button and Manual Routing Request module will open up Enter the information about the request type member and date of service then click Proceed to upload documentation Appeal Reconsideration Request Manual Routing Request Please be advised that you are submitting manual Appeal Reconsideration request A team member will review your request within 72 hours if your request is Expedited PreService appeal Otherwise you will receive a reply within 30 days Please enter one of the following combinations below a HICH and dates of service b first name last name date of birth and dates of service c Subscriber ID and dates of service Request Type Pre Service hul Doc ID Subscriber ID HICH Beneficiary Medicare Number Member First Name Member Last Name Member Date of Birth MMIDD Y YYY Date of Service From Date IMM DD rYYvv Date of Service Thru Date IMM DD YYYY Pre Service Expedited Appeal Proceed to upload documentabon Cancel Upload documentation and submit For more information see the Submit Documents on previous section Appeal Reconsideration Hi
41. lus UM Provider Fact Sheet of Auth Rules Claim amp Payment Filing State Medicaid Claim A state based instruction far filing claims with Care Improvement Plus for Dual Advantage Plan Members Remittance Learn how to read a Care Improvement Plus Remittance statement Non Contracted Provider Payment Guide A guide fram Care Improvement Plus regarding reimbursement far nan contracted providers Medicare Advantage Payment Guide A guide fram CMS regarding reimbursement by Medicare Advantage MA Plans far network and aut of network providers Voluntary refund submission form Claim to submit refund due to owerpayment Medical Record Reimbursement Medical Record Reimbursement This form is for Post Payment Medical Necessity Medical Record reimbursement Part D Claim e Maccine Claim Form This claim farm is for reimbursement of covered Part D vaccines and their administration injection Rx Claim Paper Claim Farm Farm for filing a claim to request payment Part D Mail Order Form Mail Order Form For obtaining prescription drugs by mail Page 33 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries W o Selecting a state from the state drop down boxes will display specific information relevant to those states o The Forms amp Guide section has the new feature listed as Approved Recovery Category un der the section Manual and User Guide Members 1 800 204 1090
42. lutions 2 668 15 On the Claim Details page you will see six sections e Claim Summary e Remittance Information e Payment Information e Payment summary e Post Payment Audit Reports e Claim Items e Claims bundled into same check If any Provider User Guide Copyright 2015 2015 Page 15 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries W On claim summary page you can find the claim and associated details to it such as claim id Member ID Patient account Number If any Coverage Type Dates of service Servicing Provider Claim received date Claim Status Primary Diagnosis Code If any Place of Service Reason and Note for the given claim if any Beside this information on claim detail page hovering the cursor on Servicing Provider Name will show the servicing provider address while hovering the cursor on EXPL Code of Claim Items will show explanation Note for that selected code There are four additional buttons available on this page e Request Remittance Details e Dispute e All Post Payment Audit Reports e Export to Excel To export claim line items and Bundled claims details Post Payment Audit Reports will display any relevant data for the claim If there is no audit report data available it will state no pertinent data for this report as shown in the figure above Clicking the Request Remittance Details button will display an image of the Remit if th
43. ments in electronic Medical Records eMR Upload View Provider Alert in Home menu based on Patient Care Opportunity Report PCOR measures Providers may now upload the Authorization of Representative AOR For formal appeals providers may now upload the Waiver of Liability WOL licaid Inf Provide Filing Claim information for State base Dual Advantage Plan Member Document Upload 1 Medical Records Submit Medical Records electronically for Post Payment Audit Reviews 2 Appeal Reconsideration Upload Submit missing medical records or additional documentation electronically for Appeal or Reconsideration request Reports 1 Post Payment Audit Medical Records Request Provide status report of submitted medical records and or additional documentation Audit Findings Provide status of a claim audit Reconsiderations and Appeals Activities Provide status of a Reconsideration and or appeal Payment Summary This report allows providers to review claims payments and or recoveries processed on a remit Stargazer Report This report displays list of members who are assigned to provider office and action required on specific measures for them PCOR CIP Patient Care Opportunity Report for CIP members This report provides information regarding members where screenings or tests are recommended Copyright 2015 2015 Forms amp Guide Reports Contact Us Release Note V7 2 d EMR Portal Guide Sequ
44. n Eligibility user the user will have limited access to the portal The following menu will be Member Inquiry The section offers several options to retrieve member information as well as verify the member eligibility and eligibility history Video Tutorials Featured Video Tutorial How to request a remit if one is not immediately available o m ee S ee ma Forms and Guides Provide all forms and guides related to Prior Authorization Claim amp Payment Member amp Benefit Information Part D Claim Part D Coverage Determination and Redetermination Part D Mail Order Form Release Note V7 1 EMR Portal Guide Sequestation Implementation Provider Portal User GuideNew e Featured Training How to request a remit if one is not immediately available Provider News e Provider Communication Inpatient Part A Provider Fact Sheet e Provider Communication Wellness and Physical Examination Codes e Provider Communication Inpatient Rehabilitation Facility Documentation Guidelines e Provider Communication Electronic Prescribing Bonus Incentive Payment e Provider Communication KX Modifier Therapy Services Contact Us Provide Health Plan contact information for available e mail fax and phone numbers Allow the user to send feedback on feature and functionality Provider User Guide Copyright 2015 2015 Page 7 of 53
45. nter Medicaid info Medical Records Provider News Forms amp Guide Reports FAQs Contact Us The user can find video tutorials on the following topics e How to self register e How to verify member eligibility e How to search claims and viewing claim details e How to dispute a claim e Medical Records Upload e How to request a remit if one is not immediately available e How to view forms and guides e How to view provider news e How to verify post payment audit e Appeal and Reconsideration Upload Provider User Guide Copyright 2015 2015 Page 50 of 53 W CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries The user can also access the Self Registration Tutorial through the Log In page Login Information Please enter your username and password Welcome to the Care Improvement Plus Provider Portal Username Whether you are a Participating or Non Participating Provider yeu can access the Provider Portal If you want to register as a new user please click Self Register Did you forget your password Click here To access the tutorial videos click on Tutorial link and the page with tutorial videos will open up Click on the video icon or the video topic to play the video The video will be played in a new window after clicking on the Pi icon Provider User Guide Copyright 2015 2015 Page 51 of 53 W CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries User Tutorials e
46. o export the Medical Upload History in excel document by clicking on Export to Excel button For more information on how to use this specific feature please go to Forms amp Guides by ei ther clicking the main menu tab or the header tab on the dashboard landing page and click the Provider User Guide Copyright 2015 2015 Page 24 of 53 v CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries EMR Portal Guide link found within the Manual and User Guide panel Or simply click this link https providerportal careimprovementplus com pdf XLHealth EMR Guide pdf 3 9 2 Appeal Reconsideration Upload The Appeal Reconsideration Upload module allows the users to electronically upload the documents to support the appeal amp reconsideration request This module automatically identifies the provider details as a part of provider portal account and hence makes the appeal submission easier and faster User can upload supporting documentation submit manual routing request view and update previous request and export previous submission history to excel for Appeal amp Reconsideration activities CIP Provider users can submit the following types of requests and supporting documentation Requestor Type Required Supporting Documents At least one of the following must be attached Assignment of responsibility AOR Waiver of liability form WOL 1 5 additional documents 1 5 additional documents at least one document required
47. ollowing o Members First Name or Last name Minimum 2 letters AND Any one of the following o Subscriber ID o Medicare Number o Medicaid o Date of Birth Provider User Guide Copyright 2015 2015 Page 9 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries W Enter the member information as per search parameters and click on Search and it will list the results associated with the search request You also have the option of narrowing down the search by adding any additional information in the Additional Search Criteria box though this is not required e If you want to do multiple searches at one time you can enter the same combination above and click on Add to Mass Search List Once you have added all of the members that you were looking for into the Mass Search List you can then click on Search and it will pull all results for those names Mass Search List Subscriber ID Last Name First Name Medicare Medicaid DOB City State Zip Effective Date Delete m i 1 1 1 T smith jones a EI x e Another feature under the Member Inquiry is Export to Excel This button allows you to save and print an excel spreadsheet of members you received in your Search Results Eligible YES e After you have located your Member click on the Subscriber ID link to access the details of their record in the Member Details screen Member Det
48. papents who are s members This report mcludes patient care opportunities for E who meet ontena for healthcare services specific to evidence based q i j Pari wiiwcwrt Pat O messures c Hedcaim afete memos or Pw IPC wie m dpisved tor pror year shemo nw bnt days sonadhermon t maton 1 Premcriber t Frome t Fil Date 5 20 2014 Provider User Guide Copyright 2015 2015 Page 46 of 53 W CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries MA PCPi Level Summary Report This Report displays a summary for each individual MA PCPi group of the status of all HQPAFs distributed and returned for all MA PCPi participating groups as well as a Quality Measure Summary for incomplete forms and completed forms Incomplete forms include all members for whom a HQPAF was generated minus the forms that were returned with patient status exceptions and the completed forms that went through the coding recording process Completed forms are those that went through the coding recording process Additionally the number of members required to reach HEDIS and SUPERIOR adherence rates and the number of forms required to reach the 6096 threshold are shown MA PCPI Level Summary HRM Rx Alternatives Glossary Export to Excel MA PCPI Level Summary Report The following data shows metrics for HEDIS and HOS measures that indicate a potential care opportunity Metrics include Medicare members specific to the MA PCPi
49. pecialized Care for Medicare Beneficiaries Last Wellness Exam Displays date that this member had a wellness exam although not necessarily with the physician to which the member is currently assigned Last Wellness Exam will be determined by the most recent claim with the following procedure codes CD 9 CM Diagnosis Codes V70 0 V70 8 V70 9 HCPCS codes G0402 G0438 and G0439 CPT Codes 99385 99387 and 99395 99397 This report also displays the detailed information about Physician Patient type New Existing Member details Care score Last wellness Exam and different quality measures for that member Pharmacy Detail Report Provides objective member specific information including drug name s dates prescriptions were last filled Prescriber and Pharmacy information This report may be used to proactively close gaps HRM Bx Alternatives pharmacy Detail Report According to our records the following patients have been identified as having Care opportunities for preventive services for selected quasty andicatorz based on the nationally recognized HEDIS performance measurement set Please check your records to validate the informaton and if the patent needs these or other services we would appreciate you performing those services We understand that some of the pabents may requre more than one visit to meet the required prevantrve care We hope you find this nformaton useful and appreciate the care you provide to your
50. r Member Patient Ref Id Tax Id This Check Paid Date Claim Amount Amount Id Name r 1 7 7112 6500 0 0000 112 6500 f VIG alls i J 112 6500 0 0000 112 6500 r L J 112 6500 0 0000 112 6500 E Ji e he Payment Summary Report is a unique report type that allows you to search by a specific Patient Account number or Check Reference ID along with the Tax ID or NPI number Users must also select a date range either by the Date of Service or by date the check was processed and paid for e Users have the option to export and save the information into an Excel document The data is displayed in the excel sheet by table column and in the same order as it appears within the application Provider User Guide Copyright 2015 2015 Page 38 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries W Stargazer Report The Provider Portal will display any members which are assigned to their office and each member will have a column for a specific measure Based on the contents of each column will determine the action required for each member Provider user can search the Member otars Detail by selecting the associated TAX ID or NPI and then clicking on the Search button Hours 8 00 AM 8 00 PM 7 days a week Sales 1 800 711 1656 Members 1 800 204 1002 Providers 1 866 679 3119 o Hello Log Out V 6 2 Tutorials N A CARE IMPROVEMENT PLUS r e E N O S OOT User Name Specialized Care for Medicare Beneficiari
51. r group Provider User Guide Copyright 2015 2015 Page 43 of 53 Physician Level W Summary Report CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries summarizes by physician MPIN the number of members for each recommended HEDIS and Part D measure Additionally the number of members eligible for the screening as well as current and prior reporting period compliance is shown Quality Outcomes and Clinical Performance represent performance based on HEDIS and or STAR specifications Physician Level Summary HRM Rx Alternatives C08 Adult BMI Assessment 1 0 00 96 C10 Care for Older Adults Medication Review 100 00 C11 Care for Older Adults Functional Status 1 100 00 96 Assessment This report displays following key fields Glossary Export to Excel Physician Level Summary Report Total Physicians Total Patients Total Open Care Opportunities The following data shows metrics for HEDIS measures that indicate a potential care opportunity Metrics include Medicare members specific to SUPERIOR Members Physician Name Quality Measure ee kis Em paula pa mi m Patients Opportunities Adherent Rating Adherent SUPERIOR Target Compliance 5 Target Compliance C01 Colorectal Cancer 1 0 00 3 1 r 1 Screening Relevant Patients All members assigned or attributed to a physician in the group that have at least one open or closed care opportunity for any of the HEDIS and Part D metrics identi
52. r that you received available for the claims you want to upload the documents You may chose Click here to upload a Medical Record by using Claim ID if you do not know or do not have the Document ID available Provider User Guide Copyright 2015 2015 Page 21 of 53 W CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries Home Member Inquiry Claim Center Medicaid Info Document Upload Provider News Forms amp Guide Reports FAQs ContactUs Admin Document Upload If user s account is associated with multiple Tax ID NPIs then user should select the one from the Provider Tax ID NPI drop downs menu Provider User Guide Copyright 2015 2015 Page 22 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries W Facility Provider Medical Record Upload History To upload a Medical Record please choose the Provider NPI from the menu You may provide a Click the Expanded Upload History different email address for receiving the confirmation button to see detailed Upload History Provider Facility Name 2 Medical Records were uploaded Most recent completed upload Provider Name Document ID Claim Provider Tax ID Upload Date Provider Email Expanded Upload History Confirmation Email Address Medical Record Request Letter Please choose a claim from the list below EE Hel men l Document ID I don t have a documert ID P Claims Member Patient Account Number Subscriber
53. rname and Password If you forgot your password click Forgot Password and enter your Username and email address on file then click Reset Password Your password reset link will be emailed to you on the email address we have on file If the User does not have an account the user can click the Self Register button If the User clicks the Self Register button the user will need to select one of the two options listed a o view Member Eligibly only Eligibility user e Select radio button I agree to use the Provider Portal to view Eligibility Only gt Click Agree e Fill in all user Registration Information red asterisk indicates information that is required gt Provider User Guide Copyright 2015 2015 Page 4 of 53 T CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries e Please note that the password must contain at least one digit one upper case one lower case one special character range between 8 15 characters and should not be a user name e Once you enter the entire user registration information click on Register you will be prompted to go to the login screen W CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries Eligibilty User Registration First Name ii User Name Last Name T Password T Occupation Title Confirm Password T Facility Name j T Primary Phone Email Address Fax Your account has been created Go to Login Screen Y Privacy policy
54. ssion Portal Pravider Directory Search providers within Care Improvement Plus provider network Appeals amp Reconsideration a Waiver of Liability Farm for Waiver of Liability Payment Dispute Process for Nen contracted Medicare Providers Farm for Claim Payment Dispute Request Ferm for Non Participating Providers Payment Dispute Resolution A guide from Care Improvement Plus regarding the payment dispute resolution process for non par providers Member amp Benefit Information Appointment of Representative Form Form to appoint the individual demonstrates legal authority Authorization to Release form Farm to delegated the authority by submitting to the plan a signed Authorization to release form Quick Reference Guide State base 4 State base Benefit Overview information ie Copay and plan information Health Plan Benefit Summary State based link to Benefit at a Glance 4 Part D Coverage Determination and Redetermination Coverage Determination Form Form to request prescription drug coverage determinations and exception Coverage Determination Instruction Instruction to request prescription drug coverage determinations and exception Rx Redetermination Form to request for Medicare Prescription Drug Appeal Provider User Guide Copyright 2015 2015 Prior Authorization e Provider Preauthorization Form Form to request preauthorization Provider Authorization Requirements Care Improvement P
55. story User can view all the total numbers of Appeal Reconsideration document Upload and Most recent upload details via Appeal Reconsideration history Clicking on Appeal Reconsideration History will show all previously uploaded documents by the user The Appeal Reconsideration history section allows the user to update previously uploaded appeals or reconsideration documents Once a document is uploaded the provider is given a new confirmation number with a revised date for the date of submission for the appeal reconsideration Provider User Guide Copyright 2015 2015 Page 31 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Bencficiaries 3 Appeal Reconsideration Upload Facility Provider Appeal Reconsideration History Click the Appeal Reconsideration History button to see detailed Upload History Provider Name No Appeals Reconsiderations were uploaded Provider Facility Name Provider Tax ID Provider Email Confirmation Email Address Search by Upload Date From MMIDO YYYY t teen Hn Member Normie Member PON ELIMINA NI 11 04 2013 14 03 XXX 11 04 2012 14 0 11 04 2013 14 03 11 04 201J 14 02 You can also export the Appeal Submission History to excel file by using Export to Excel button Appeal Reconsideration Request Search by Upload Date From MMDDYYYY 7 rodjMwoDvvvv Search ClearSearch sett sees nesters Upload Date Type Confirm
56. t Upload Provider News Forms amp Guide Reports FAQs Patient Care Opportunity Report PCOR Year 2015 PCOR Criteria Tax ID Select Report Type e Group Level Summary Report MA HIP Summary Report Physician Level Summary Report Member Adherence Report Pharmacy Detail Report MA PCPI Level Summary Report Generate Report This Report provides information regarding members for whom screenings tests are recommended Data represents claims processed as of 9 20 2015 Contact Us User can select the Tax ID and report type and click on generate report These reports can be export to excel sheet by using Export to Excel button located on top right corner of each report This button allows you to save and print an excel spreadsheet of members you received in your Search Results User can also view the High Risk Medication Alternatives and glossary for this report located at top left corner of the each report User can scroll the report horizontally through the scrollbar and also jump to another page by clicking on the page number located below the table e Group Level Summary Report summarizes by group TIN the number of members for each recommended HEDIS measure Additionally current and prior reporting period compliance as well as current STAR rating is provided Quality Outcomes and Clinical Performance represent performance based on HEDIS and or STAR specifications CARE IMPROVEMENT PLUS Specialized Care for M
57. tails which are generated from the database All Member information will be protected unless the User has access to view the Claims infor mation by NPI or Tax ID Provider User Guide Copyright 2015 2015 Page 14 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries W 3 3 1 Claims Details page Claim Summary Remittance Information Claim ID Provider Name Member ID n Address Covered Under Care Improvement Plus Silver Plan 1009 o Subsidy amp Patient Acct NPI Dates of Service 05 10 2011 to 06 01 2011 Paid on this Claim Servicing Provider z R t Remittance Detail ieran Payment Information Status PROCESSED hock Ribi Primary Diagnosis Code 27803 DRG Code 208 Payment Ref ID Payment Date Check Amount Place of Service Note sciens Combined Check Check Status All Post Payment Audit Reports Dispute Request Post Payment Audit Reports Medical Records Request Audit Findings Reconsiderations and Appeals Activity No pertinent data for this report Chart Racca Yes No pertinent data for this report Audit Date 11 13 2011 Determination Pass Claim Items This claim has 22 Line item s Export To Excel Proc aa z x EXPL Cod Description Cod 0110 Room amp Board Private 19 431 20 22 549 21 0 00 1 132 00 0250 Pharmacy 29 962 80 0 00 0 00 0 00 Pharmacy Drugs Incident to Radiology 1500 sooo 0 00 sowo S600 Pharmacy IV So
58. to identify CIP member daims benefits and eligibility The materials and information on the portal are private and may contain confidential protected health information PHI that is legally privileged This information is intended only for the use of the individual or entity being provided with access to the CIP Provider Portal The authorized recipient of this information is prohibited from disclosing this information to any other party unless required to do so by law or regulation and is required to destroy the information after its stated need has been fulfilled If you are not the intended recipient you are hereby notified that any disclosure copying distribution or action taken in reliance on the contents af the information on the Provider Portal is stricthy prohibited Clicking OK will bring the user to the next step to enter the e mail address add a message and at tach Excel only files which are related to the claim I d N Your notification to Care Improvement Plus is ready to be sent Please add any additional comments you feel would be pertinent All attached files must be in Microsoft Excel format When finished click Send Notification or press Cancel to return to Claim Summary screen Email Address Required a Provider User Guide Copyright 2015 2015 Page 19 of 53 CARE IMPROVEMENT PLUS Specialized Care for Medicare Beneficiaries Your notification to Care Improvement Plus is ready to b
59. viously uploaded documents by the user Medical Record Upload Facility Provider To upload a Medical Record please choose the Provider NPI from the menu Please enter your email address to receive an email confirmation Medical Record Upload History Click the Expanded Upload History button to see detailed Upload History Provider Facility Name Provider Name Provider Tax ID Provider Email Confirmation Email Address 20 Medical Records were uploaded Most recent completed upload Document ID Claim Upload Date Expanded Upload History Medical Record Request Letter Please type the Document ID that you have received in the Medical Record Letter and then click the Submit button If you cannot find the Document ID please click on the Help Document ID lookup button below to open Medical Record Letter template Medical Record Upload Medical Record History Search by Upload Date From MM DD YYYY To MM DD YYYY Member Exportto Excel Member Total Doc ID Claim ID ME DOB Uploaded By Uploads Upload Date Confirmation Update 10 16 2014 Update 1 14 08 Update 10 08 2014 Medical Record File has been naim 11 41 updated Back to Upload You can filter the list by entering the upload From and To dates then click on Search By clicking on Update button user can change update the previously submitted document You can als

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